Egyptian Heart Journal最新文献

{"title":"The value of three-dimensional color Doppler trans-esophageal echocardiography in predicting the number of MitraClip devices needed during the procedure","authors":"Hani M. Mahmoud ,&nbsp;Ali M. Al-Ameen ,&nbsp;Mohamed H. Hassan ,&nbsp;Tarek Badr ,&nbsp;Hesham Nieem ,&nbsp;Ahmed A. Shaheen ,&nbsp;Abdullah E. Ghabashi","doi":"10.1016/j.ehj.2017.03.004","DOIUrl":"10.1016/j.ehj.2017.03.004","url":null,"abstract":"<div><h3>Purpose</h3><p>During MitraClip procedure, one or more clips might be needed to effectively reduce the mitral regurgitation (MR). Three-dimensional vena-contracta (3D-VC) assessed by color Doppler three-dimensional trans-esophageal echocardiography (3D-TEE) was proven to be well correlated with MR severity. However, its role in predicting the number of MitraClip devices needed during the procedure was not fully determined. Aim of this study is to assess the predictive value of 3D-VC area &amp; length in determining the number of clips needed during the procedure.</p></div><div><h3>Methods</h3><p>3D-TEE with color Doppler was performed in 20 patients ( age: 68.9<!--> <!-->±<!--> <!-->2.5 years; 65% males; with functional severe/moderately severe MR) who underwent successful MitraClip procedure (reduction of MR to &lt;2+). Manual tracing and measurement of the 3D-VC area (3D-VCA) as well as the 3D-VC length (3D-VCL) was done. These values were compared between patients who received 1 clip (n<!--> <!-->=<!--> <!-->4) and ≥ 2 clips (n<!--> <!-->=<!--> <!-->16).</p></div><div><h3>Results</h3><p>Patients who received ≥ 2 clips had larger 3D-VC area compared to patients who received 1 clip (0.39<!--> <!-->±<!--> <!-->0.23<!--> <!-->cm² vs. 0.13<!--> <!-->±<!--> <!-->0.03<!--> <!-->cm², <em>p</em> <!-->=<!--> <!-->0.04, <em>t</em> <!-->=<!--> <!-->2.22) . Patients who received ≥ 2 clips had bigger 3D-VC length compared to patients who received 1 clip (1.14<!--> <!-->±<!--> <!-->0.33 cm vs. <em>p</em> <!-->=<!--> <!-->0.005, <em>t</em> <!-->=<!--> <!-->3.25 ). A cut-off values of 0.20<!--> <!-->cm² &amp; 1<!--> <!-->cm for the VCA &amp; VCL respectively, are suggestive that the patient will most likely require more than one MitraClip device to treat his mitral regurgitation.</p></div><div><h3>Conclusions</h3><p>The 3D-VCA &amp; 3D-VCA using 3D TEE is helpful indetermining the number of MitraClip devices needed during the procedure in functional mitral regurgitation.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 4","pages":"Pages 247-251"},"PeriodicalIF":1.1,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35983466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of a predictive model for paravalvular aortic regurgitation after transcatheter aortic valve implantation with a self-expandable prosthesis","authors":"Ahmad E. Mostafa ,&nbsp;Gert Richardt ,&nbsp;Mohamed Abdel-Wahab","doi":"10.1016/j.ehj.2017.06.004","DOIUrl":"10.1016/j.ehj.2017.06.004","url":null,"abstract":"<div><h3>Background</h3><p>A predictive model for Paravalvular aortic regurgitation (PAR) integrating the left ventricular outflow tract-to-ascending aorta angle (LVOT-AO) and depth to the non-coronary cusp (NCC) after TAVI with CoreValve prosthesis (MCP) was retrospectively identified (2<!--> <!-->×<!--> <!-->∠LVOT-AO<!--> <!-->+<!--> <!-->[depth to NCC-10]2; cutoff<!--> <!-->=<!--> <!-->50). However, the validity and clinical utility of this model remain unknown.</p></div><div><h3>Methods</h3><p>A total of 100 patients (79.6<!--> <!-->±<!--> <!-->7<!--> <!-->years, mean EuroScore 24.9<!--> <!-->±<!--> <!-->16.3%, 41 males) constituted a validation cohort for the predictive model. Both angle (LVOT-AO) and depth to NCC were considered during patient selection and device implantation.</p></div><div><h3>Results</h3><p>Significant AR occurred in 16% (group A) vs. 84% (group B). Angle ∠LVOT-AO and depth to NCC were larger in group A compared to group B (16.4<!--> <!-->±<!--> <!-->7.2 vs. 11.8<!--> <!-->±<!--> <!-->4.1, <em>p</em> <!-->&lt;<!--> <!-->0.001, and 9.1<!--> <!-->±<!--> <!-->4.8<!--> <!-->mm vs. 6.6<!--> <!-->±<!--> <!-->2.7<!--> <!-->mm, <em>p</em> <!-->=<!--> <!-->0.004). The model showed a sensitivity of 68.7% and a specificity of 88.1% in prediction of PAR. Comparing the derivation cohort (initial experience, <em>n</em> <!-->=<!--> <!-->50) and validation cohort (later experience, <em>n</em> <!-->=<!--> <!-->100) it is showed that the ∠LVOT-AO, valve depth and PAR were significantly lower (12.5<!--> <!-->±<!--> <!-->4.9 and 6.9<!--> <!-->±<!--> <!-->3.2<!--> <!-->mm vs. 19.7<!--> <!-->±<!--> <!-->7.9 and 10.4<!--> <!-->±<!--> <!-->3.7<!--> <!-->mm, 40% vs. 16% respectively, all <em>p</em> <!-->&lt;<!--> <!-->0.001) in the validation cohort.</p></div><div><h3>Conclusion</h3><p>The predictive model for significant PAR after TAVI using MCP is valid with a reassuring specificity and an acceptable sensitivity. A strategy incorporating these anatomical and procedural variables improves PAR after TAVI.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 4","pages":"Pages 253-259"},"PeriodicalIF":1.1,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35983467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease and ABO blood-groups in Africans. Are blood-group A individuals at higher risk of ischemic disease?: A pilot study","authors":"Djibril Marie BA ,&nbsp;Mamadou Saidou Sow ,&nbsp;Aminata Diack ,&nbsp;Khadidiatou Dia ,&nbsp;Mouhamed Cherif Mboup ,&nbsp;Pape Diadie Fall ,&nbsp;Moussa Daouda Fall","doi":"10.1016/j.ehj.2017.03.002","DOIUrl":"10.1016/j.ehj.2017.03.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Since the discovery of the ABO blood group system by Karl Landsteiner in 1901, several reports have suggested an important involvement of the ABO blood group system in the susceptibility to thrombosis. Assessing that non-O blood groups in particular A blood group confer a higher risk of venous and arterial thrombosis than group O.&lt;/p&gt;&lt;p&gt;Epidemiologic data are typically not available for all racial and ethnics groups.&lt;/p&gt;&lt;p&gt;The purpose of this pilot study was to identify a link between ABO blood group and ischemic disease (ID) in Africans, and to analyze whether A blood group individuals were at higher risk of ischemic disease or not.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A total of 299 medical records of patients over a three-year period admitted to the cardiology and internal medicine department of military hospital of Ouakam in Senegal were reviewed. We studied data on age, gender, past history of hypertension, diabetes, smoking, sedentarism, obesity, hyperlipidemia, use of estrogen-progestin contraceptives and blood group distribution.&lt;/p&gt;&lt;p&gt;In each blood group type, we evaluated the prevalence of ischemic and non-ischemic cardiovascular disease. The medical records were then stratified into two categories to evaluate incidence of ischemic disease: Group 1: Patients carrying blood-group A and Group 2: Patients carrying blood group non-A (O, AB and B).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Of the 299 patients whose medical records were reviewed, 92 (30.8%) were carrying blood group A, 175 (58.5%) had blood group O, 13 (4.3%) had blood group B, and 19 (6.4%) had blood group AB.&lt;/p&gt;&lt;p&gt;The diagnosis of ischemic disease (ID) was higher in patients with blood group A (61.2%) than in other blood groups, and the diagnosis of non-ischemic disease (NID) was higher in patients with blood group O (73.6%) compared to other groups. In patients with blood group B or AB compared to non-B or non-AB, respectively there was no statistically significant difference in ID incidence.&lt;/p&gt;&lt;p&gt;Main risk factor for ID was smoking (56.5%), hypertension (18.4%) and diabetes (14.3%).&lt;/p&gt;&lt;p&gt;In our study, there was no statistical difference between blood group A and non-A in myocardial infarction (MI) incidence (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.09, 95% CI&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.99–2.83) but a statistically significant difference between blood group A and non-A in stroke and coronary artery disease (CAD) incidence (p&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001, 95% CI&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1.80–3.37 and &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001 95% CI&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1.82–3.41 respectively) was found.&lt;/p&gt;&lt;p&gt;The incidence of ID in men was significantly higher in blood group A (95% CI&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;2.26–4.57, &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.0001) compared with non-A group, while there was no statistically significant difference in women (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.35). However, an overall effect was detected to be statistically significant regardless of gender (","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 4","pages":"Pages 229-234"},"PeriodicalIF":1.1,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35983463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute triggers of myocardial infarction: A case-crossover study","authors":"Maryam Ghiasmand ,&nbsp;Mohammad Taghi Moghadamnia ,&nbsp;Majid Pourshaikhian ,&nbsp;Ehsan Kazemnejad Lili","doi":"10.1016/j.ehj.2017.03.003","DOIUrl":"10.1016/j.ehj.2017.03.003","url":null,"abstract":"<div><h3>Background</h3><p>Acute myocardial infarction (AMI) is one of the most preventable non-communicable diseases in human. Identifying triggers of myocardial infarction (MI) and prevention ways of exposure-induced complications can reduce morbidity and mortality in people at risk.</p></div><div><h3>Aim</h3><p>The aim of this study was to identify the emotional, environmental, physical and chemical dimensions of acute triggers in patients with AMI.</p></div><div><h3>Methods</h3><p>This case-crossover study was conducted on 269 patients with AMI, hospitalized at two remedial centers in Rasht in 2015. The study samples were selected by convenient sampling method. Data were collected using researcher-made questionnaire through interviews. Hazard and control periods for each trigger and its effects on the development of MI were studied. The collected data were analyzed using descriptive and analytical statistical methods, Cochran test, and generalized estimating equation (GEE) model with logistics function default in SPSS version 21, and <em>p</em> <!-->&lt;<!--> <!-->0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>The results showed that quarrel (<em>P</em> <!-->=<!--> <!-->0.008, OR<!--> <!-->=<!--> <!-->2.01) and hearing the sudden news (<em>P</em> <!-->=<!--> <!-->0.001, OR<!--> <!-->=<!--> <!-->2.19) were the most common emotional triggers. Respiratory infections (<em>P</em> <!-->=<!--> <!-->0.0001, OR<!--> <!-->=<!--> <!-->6.78) and exposure to hot or cold weather (<em>P</em> <!-->=<!--> <!-->0.005, OR<!--> <!-->=<!--> <!-->2.19) were the most frequent environmental triggers. Doing heavy activities (<em>P</em> <!-->=<!--> <!-->0.005, OR<!--> <!-->=<!--> <!-->1.66) and sexual activities (<em>P</em> <!-->=<!--> <!-->0.003, OR<!--> <!-->=<!--> <!-->2.36) were among the most common physical triggers. High-fat foods consumption and overeating (<em>P</em> <!-->=<!--> <!-->0.0001, OR<!--> <!-->=<!--> <!-->3.79) were the most frequent chemical triggers of AMI.</p></div><div><h3>Conclusion</h3><p>It seems that given the importance of the triggers in the incidence of AMI, planning is necessary to train vulnerable individuals to reduce exposure to triggers.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 4","pages":"Pages 223-228"},"PeriodicalIF":1.1,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35983462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outflow tract ventricular premature beats ablation in the presence or absence of structural heart disease: Technical considerations and clinical outcomes","authors":"Haitham Badran,&nbsp;Rania Samir,&nbsp;Mohamed Amin","doi":"10.1016/j.ehj.2017.05.005","DOIUrl":"10.1016/j.ehj.2017.05.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Premature ventricular beats (PVBs) are early depolarization of the myocardium originating in the ventricle. In case of very frequent PVBs, patients are severely symptomatic with impaired quality of life and are at risk of pre-syncope, syncope, heart failure, and sudden cardiac death particularly in the presence of structural heart disease. Ventricular outflow tracts are the most common sites of origin of idiopathic PVBs especially in patients without structural heart disease. We examined the role of radiofrequency catheter ablation in suppression of monomorphic PVBs of outflow tract origin in the presence or absence of structural heart disease, and its impact on improvement of left ventricular (LV) systolic function.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Thirty-seven highly symptomatic patients with PVBs burden exceeding 10% were enrolled, provided that PVBs are monomorphic, originating in ventricular outflow tracts and regardless the presence or absence of structural heart disease. Patients were divided into 2 groups according to PVB site origin (RVOT vs. LVOT). 3D electro-anatomical mapping modalities were used in all patients employing activation mapping technique in the majority of cases. Acute success was considered when PVBs completely disappeared or when residual sporadic PVBs&lt;!--&gt; &lt;!--&gt;≤&lt;!--&gt; &lt;!--&gt;1 beats/min or ≤10&lt;!--&gt; &lt;!--&gt;beats/30&lt;!--&gt; &lt;!--&gt;min after RF ablation. Patients were followed up for a mean period of 5.4&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.2&lt;!--&gt; &lt;!--&gt;months with long-term success defined as complete disappearance or marked reduction by more than 75% in the PVBs absolute number on 24 h holter monitoring.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Mean age of the study group was 39.9&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;12.97&lt;!--&gt; &lt;!--&gt;years, including 22 (59.4%) males. PVBs originated in RVOT in 17 cases and in LVOT in the remaining 20 cases. Prevalence of structural heart disease and consequently shortness of breath was higher in LVOT group. Initial ECG localization matched EP localization in the majority (94%) of cases. R wave duration index was the only significant independent predictor for RVOT origin with cut off value of &lt;0.3 (P&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0057) upon multivariate analysis. Acute success was encountered in 32 (86%) patients with all cases of failure in the LVOT group. Recurrence occurred in 5 (15%) cases without significant difference between both groups. All cases of recurrence had residual PVBs at the end of the procedure. 18 cases out of the study group showed significant improvement of their EF (&gt;5%) at the end of the follow-up period with no significant differences between both groups (p&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.09). A linear correlation was observed between PVBs burden at follow up and magnitude of improvement of LV EF, particularly in patients with resting LV dysfunction and increased LV internal dimensions.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;RF ablation is an effective and safe method for elimination of outf","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 4","pages":"Pages 273-280"},"PeriodicalIF":1.1,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.05.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35983469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic predictors of atrial fibrillation after mitral valve replacement","authors":"Al-Shimaa Mohamed Sabry,&nbsp;Heba Abd El-Kader Mansour,&nbsp;Tarek Helmy Abo El-Azm,&nbsp;Shimaa Ahmed Mostafa,&nbsp;Basant Samy Zahid","doi":"10.1016/j.ehj.2017.07.002","DOIUrl":"10.1016/j.ehj.2017.07.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Detection of the echocardiographic predictors of post-operative atrial fibrillation in patients with rheumatic mitral valve disease undergoing mitral valve replacement.</p></div><div><h3>Methods</h3><p>The study included 50 patients with rheumatic mitral valve disease undergoing mitral valve replacement. Preoperative assessment included standard two-dimensional echocardiography to assess LA diameter, volume, and emptying fraction, LV volume and ejection fraction. TDI derived velocity, strain of the left atrium and speckle tracking to assess left ventricular function then postoperative follow up for 1<!--> <!-->month for occurrence of atrial fibrillation.</p></div><div><h3>Results</h3><p>The incidence of postoperative AF was 44%; these patients were significantly older (<em>P</em> <!-->=<!--> <!-->0.001) and show higher prevalence of DM (<em>P</em> <!-->=<!--> <!-->0.001) and HTN (<em>P</em> <!-->=<!--> <!-->0.001). Also, LA diameters (antero-posterior, transverse and longitudinal) and LA volumes (maximal and minimal) were increased (<em>P</em> <!-->&lt;<!--> <!-->0.001), but no difference in LA emptying fraction (<em>P</em> <!-->&gt;<!--> <!-->0.05). Systolic LA strain and left ventricular global longitudinal strain were significantly reduced in those patients (<em>P</em> value &lt;0.001). Echocardiographic predictors of AF were LA systolic strain (<em>P</em> value &lt;0.001) and LV global longitudinal strain (<em>P</em> value<!--> <!-->=<!--> <!-->0.003). Cutoff value for systolic LA strain ≤23 had sensitivity 90.91% and specificity 93.33% in predicting POAF. While, left ventricular global longitudinal strain ≤−14.9% had sensitivity 63.6% and specificity 100.0% in predicting AF.</p></div><div><h3>Conclusion</h3><p>LA systolic strain and LV global longitudinal strain were significant predictors of POAF. Echocardiographic parameters can identify patients at greater risk of developing POAF who can benefit from preventive measure and guide the selection of prosthesis.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 4","pages":"Pages 281-288"},"PeriodicalIF":1.1,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35981414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of chronic pretreatment with beta-blockers on no-reflow phenomenon in diabetic patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention","authors":"Ali Mohammed Kareem Al-Jabari ,&nbsp;Ahmed Shawky Elserafy ,&nbsp;Hossamaldin Zaki Alsayed Abuemara","doi":"10.1016/j.ehj.2017.01.001","DOIUrl":"10.1016/j.ehj.2017.01.001","url":null,"abstract":"<div><h3>Background</h3><p>No-reflow is an important factor as it predicts a poor outcome in patients undergoing primary angioplasty. In comparison with patients attaining TIMI 3 flow, patients with no-reflow have an increased incidence of ventricular arrhythmias, early congestive cardiac failure, cardiac rupture and cardiac death. As such, it is of paramount importance to consider strategies to prevent the occurrence of no-reflow phenomenon. Previous evidence suggests that Beta (β) blockers have multiple favorable effects on the vascular system not directly related to their effect on blood pressure. However, there are insufficient data regarding the effects of prior Beta blocker use on coronary blood flow after primary PCI in patients with AMI.</p></div><div><h3>Aim</h3><p>The aim of this study was to test the hypothesis that Beta blocker treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after acute myocardial infarction.</p></div><div><h3>Methods and results</h3><p>The study included 107 diabetic patients who had presented with acute STEMI within 12<!--> <!-->h from the onset of chest pain. All of them have undergone primary angioplasty at Ain Shams University hospitals or National Heart institute. The incidence of no-reflow phenomenon was 21%. No-reflow phenomenon was significantly lower in patients on chronic B-blocker therapy (12% vs. 28%; <em>P</em> <!-->=<!--> <!-->0.04). The heart rate was significantly lower in the normal reflow group than in the no-reflow group (<em>P</em> <!-->=<!--> <!-->0.03). The study also showed that B-blocker pretreatment is an independent protective predictor for the no-reflow phenomenon (P<!--> <!-->=<!--> <!-->0.045).</p></div><div><h3>Conclusion</h3><p>Chronic pre-treatment with B-blocker in diabetic patients presenting with STEMI, is associated with lower rate of occurrence of no-reflow phenomenon after primary PCI.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 3","pages":"Pages 171-175"},"PeriodicalIF":1.1,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.01.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35980920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemia modified albumin (IMA) in acute coronary syndrome (ACS) and left bundle branch block (LBBB). Does it make the difference?","authors":"Mohamed Abdel Kader Abdel Wahab","doi":"10.1016/j.ehj.2017.01.004","DOIUrl":"10.1016/j.ehj.2017.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Management of patients with a suspected ACS and LBBB is a challenge to the clinician.</p></div><div><h3>Aim</h3><p>To detect the ability of IMA to exclude myocardial ischemia in suspected patients with ACS and LBBB.</p></div><div><h3>Material and methods</h3><p>A total of 68 patients with suspected ACS and LBBB (group I) and another twenty patients age and sex matched known to have LBBB with normal coronary angiography (group II) were included in this study and subjected to: routine laboratory tests, 12 lead ECG, echocardiography, and measurement of serum troponin I (TnI) and IMA (measured by ELISA). Diagnostic coronary angiography was performed on all patients and scored by severity and modified Gensini scores.</p></div><div><h3>Results</h3><p>IMA and TnI levels are significantly increased in group I compared to group II (P value &lt;0.001<strong>)</strong>. IMA with a cutoff value &gt;95 could predict significant CAD (lesions &gt;50%) with AUC of 0.923, sensitivity of 88%, specificity of 83.33%, PPV of 93.6%, NPV of 71.4% and accuracy 86.76%. Moreover, by using both simple and multiple logistic regression analyses IMA could also independently detect significant CAD. The combined use of IMA and TnI significantly improved the sensitivity and the negative predictive value to 98% and 90.9% respectively.</p></div><div><h3>Conclusion</h3><p>There was a distinct advantage of measuring IMA in patients presenting to the emergency department with acute chest pain and LBBB to rule out a final diagnosis of ACS.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 3","pages":"Pages 183-190"},"PeriodicalIF":1.1,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35980922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with non-obstructive coronary artery disease admitted with acute myocardial infarction carry a better outcome compared to those with obstructive coronary artery disease","authors":"Yasser Yazied Abdelmonem,&nbsp;Adel Abdelgawad Bakr,&nbsp;Hossam Ghanem El-Hossary,&nbsp;Mohammed Mahmoud Abdel Ghany","doi":"10.1016/j.ehj.2017.03.001","DOIUrl":"10.1016/j.ehj.2017.03.001","url":null,"abstract":"<div><h3>Background</h3><p>The characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.</p></div><div><h3>Aim</h3><p>The present study aimed to investigate the clinical profile, in-hospital and 3-month outcome of AMI patients with insignificant coronary stenosis in comparison with those with significant disease.</p></div><div><h3>Methods</h3><p>This prospective observational study included 200 consecutive patients admitted with AMI. Group I (100 patients) included patients with insignificant CAD (all lesions &lt;50% stenosis). Group II (100 patients) included patients with one or more lesions &gt;70% stenosis. Patients with previous CABG were excluded. Patients with significant CAD had successful total revascularization.</p></div><div><h3>Results</h3><p>Patients with insignificant CAD were significantly younger (61<!--> <!-->vs. 67<!--> <!-->years, p<!--> <!-->&lt;<!--> <!-->0.001), more likely to be females<!--> <!-->(41% vs. 23%, p<!--> <!-->=<!--> <!-->0.006), less likely to smoke (p<!--> <!-->=<!--> <!-->0.006), less likely to have diabetes mellitus (p<!--> <!-->&lt;<!--> <!-->0.001), and less likely to have history of CAD (p<!--> <!-->=<!--> <!-->0.042) or prior PCI (p<!--> <!-->=<!--> <!-->0.037). They were also less likely to have typical anginal pain at presentation (61% vs 91%, p<!--> <!-->&lt;<!--> <!-->0.001), less likely to have heart failure at presentation (9% vs 30%, p<!--> <!-->&lt;<!--> <!-->0.001),<!--> <!-->less likely to have<!--> <!-->ischemic ST-segment changes on presentation (10% vs 46%, p<!--> <!-->&lt;<!--> <!-->0.001), lower peak troponin (p<!--> <!-->&lt;<!--> <!-->0.001) and CK-MB levels (p<!--> <!-->&lt;<!--> <!-->0.001), with lower LDL-C (p<!--> <!-->=<!--> <!-->0.006), and higher HDL-C level (p<!--> <!-->=<!--> <!-->0.020). They were less likely to be treated with b-blockers (p<!--> <!-->=<!--> <!-->0.002), ACEI/ARBS (p<!--> <!-->=<!--> <!-->0.007), and higher rates of calcium channel blocker therapy (p<!--> <!-->&lt;<!--> <!-->0.001). They had lower prevalence of major adverse clinical events at follow-up (readmission for ACS (p<!--> <!-->=<!--> <!-->0.009), need for revascularization (p<!--> <!-->=<!--> <!-->0.035), recurrent chest pain (p<!--> <!-->=<!--> <!-->0.009), and cardiogenic shock (p<!--> <!-->=<!--> <!-->0.029).</p></div><div><h3>Conclusion</h3><p>Patients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 3","pages":"Pages 191-199"},"PeriodicalIF":1.1,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35980923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and laboratory characteristics of short-term mortality in Egyptian patients with acute heart failure","authors":"Ahmad Tageldien Abdellah ,&nbsp;Alaa Desouky Mohamed ,&nbsp;Hamdy Ali Hendawi ,&nbsp;Magdi Ali Omera","doi":"10.1016/j.ehj.2017.02.003","DOIUrl":"10.1016/j.ehj.2017.02.003","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the clinical and laboratory predictors of short-term mortality in patients with acute heart failure (AHF).</p></div><div><h3>Subjects and methods</h3><p>We conducted a prospective, single center study on 120 consecutive patients presented with acute heart failure to the emergency department. All patients had clinical, laboratory, electrocardiographic and echocardiographic evaluation. Short-term mortality was reported within 30<!--> <!-->days of presentation.</p></div><div><h3>Results</h3><p>Mean age was 59.29<!--> <!-->±<!--> <!-->10.1<!--> <!-->years, 55.8% were males and 50.8% were smokers. The common AHF presentations were dyspnea (91.7%), chest tightness (62.5%) and lower limb edema (54.2%). Ischemic heart disease, diabetes and hypertension were present in 72.5%, 43.3% and 35% of patients, respectively.</p><p>Short-term mortality was reported in 29 patients (24.16%); most of them died in-hospital (19 patients, 65.52%). The following parameters were significantly associated with short-term mortality: hypoxia (<em>P</em> <!-->&lt;<!--> <!-->0.001), tachycardia (<em>P</em> <!-->&lt;<!--> <!-->0.01), raised jugular venous pressure (JVP) (<em>P</em> <!-->&lt;<!--> <!-->0.001), low systolic blood pressure (<em>P</em> <!-->&lt;<!--> <!-->0.01), prolonged PR interval (<em>P</em> <!-->&lt;<!--> <!-->0.007), atrial fibrillation (AF) (<em>P</em> <!-->&lt;<!--> <!-->0.038), left bundle branch block (LBBB) (<em>P</em> <!-->&lt;<!--> <!-->0.04), impaired kidney function (<em>P</em> <!-->&lt;<!--> <!-->0.007), anemia (<em>P</em> <!-->&lt;<!--> <!-->0.029), hyponatremia (<em>P</em> <!-->&lt;<!--> <!-->0.006), hypoalbuminemia (<em>P</em> <!-->&lt;<!--> <!-->0.005), dilated left ventricle (LV) (<em>P</em> <!-->&lt;<!--> <!-->0.001), low LV ejection fraction (LVEF) (<em>P</em> <!-->&lt;<!--> <!-->0.001), and dilated left atrium (LA) (<em>P</em> <!-->&lt;<!--> <!-->0.002).</p><p>ROC curve analysis showed that low LVEF (≤24%), dilated LV end diastolic diameter (LVESD)<!--> <!-->≥<!--> <!-->66.5<!--> <!-->mm, dilated LV end systolic diameter (LVESD)<!--> <!-->≥<!--> <!-->53.5<!--> <!-->mm, dilated LA diameter<!--> <!-->≥<!--> <!-->48<!--> <!-->mm, increased serum creatinine<!--> <!-->≥<!--> <!-->1.6<!--> <!-->mg/dl, and decreased serum albumin<!--> <!-->≤<!--> <!-->3<!--> <!-->g/dl can significantly predict short-term mortality in patients with acute heart failure.</p></div><div><h3>Conclusion</h3><p>Variable clinical, laboratory, electrocardiographic and echocardiographic parameters were associated with short-term mortality. Our study showed that low LVEF, dilated LV diameter, dilated LA diameter, impaired kidney function and low serum albumin can predict short-term mortality in patients with acute heart failure.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 3","pages":"Pages 201-208"},"PeriodicalIF":1.1,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.02.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35980924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}